Child mortality rates are falling, but MDG is still far off

The number of children who die before their fifth birthday declined by nearly 50 percent between 1990 and 2012, from more than 12 million to 6.6 million, according to a new UNICEF report.

Despite the good news, the world is not on track to reach the United Nations’ Millennium Development Goal (MDG) to cut the 1990 child mortality rates by two-thirds by 2015. Unless the world more than quadruples the annual rate of reduction in child death, it won’t meet the MDG until 2028.

“These targets are ambitious,” said Geeta Rao Gupta, UNICEF deputy executive director, in a press conference Thursday. But, “dramatic progress is possible — even in the most resource constrained settings.”

Most of the 6.6 million children under 5 who died in 2012 died of preventable causes. Pneumonia killed 17 percent, diarrhea killed 9 percent, and malaria killed 7 percent, according to the report. Nearly half died in the first month of life, some from diarrhea and pneumonia, to which newborns are especially sensitive, and many from birth complications like asphyxia or infections.

While all the top killers have taken fewer and fewer children over the past two decades, the most marked progress has been against diarrhea, which killed 50 percent fewer children in 2012 than it did in 1990. The battle against pneumonia and malaria has been slower, dropping by a third between 1990 and 2012.

As the numbers of children who die from infectious disease has dropped, the proportion of children who die from birth-related complications and infections during the first month of life has ballooned. In 1990, just 10 percent of deaths occurred during the neonatal period. By 2012, infants represented 44 percent of deaths.

“One of the reasons we haven’t made as much progress as we’d hoped was that, until recently, there wasn’t enough attention on newborn mortality,” said Eric Swedberg, senior director of child health and nutrition at Save the Children.

He attributes the uneven success to logistics. He used diarrhea as an example. The key to saving a child from dying of diarrhea is preventing dehydration, which can be accomplished by administering an oral solution or giving a child a zinc supplement, he said. Though distribution of ORS and zinc still need to be ramped up in many parts of the world, the treatment is cost effective and straightforward.

By contrast, saving a baby who is not breathing after birth requires a trained health professional to be ready to act, Swedberg said.

Critics of the millennium development goals weren’t surprised that the goal is a long shot.

“We were destined to fall short from the beginning,” said Elizabeth Gibbons, a visiting scholar at the FXB Center for Health and Human Rights at the Harvard School of Public Health. “A two-thirds reduction across the board was an unrealistic goal.”

Gibbons holds that the MDG is a well-intentioned, but poorly designed policy that, in some ways, may have hampered progress in child health — particularly in Africa and Asia, where children are most likely to die. She’s hardly the only one to raise such a critique. Earlier this summer, for example, one of the UN’s own statisticians independently released a paper that essentially branded the MDG ineffective, claiming the improvements in child mortality rates we’ve observed since 1990 would have happened regardless of the campaign.

A recent report published by the Harvard School of Public Health found that the MDGs, including the goal for reducing child mortality, encourage narrow approaches that rely heavily on technological solutions, while neglecting the need for broader social change or the strengthening of national institutions. For example, according to the report, pre-MDG policies took a holistic approach to low birth weight babies and malnourished children that took into account a mother’s education and social voice. Under the MDGs, on the other hand, a solution might be to pass out nutritional supplements.

Furthermore, the report found, although birth complications, pneumonia, diarrhea and malaria have long been the most formidable foes in the battle for child survival, the way the MDGs were drafted may have pulled attention away from them.

Gibbons, who co-authored the Harvard study, said the MDGs championed interventions that were easy to count rather than setting up a game plan to tackle the most aggressive child killers. For example, although measles only accounted for 4 percent of child deaths in 1990, it was included as one of just three child mortality sub goals.

Over the course of the MDGs, UNICEF reported that measles, which accounted for just 1 percent of child deaths in 2012, has seen the biggest decline of any infectious disease — by far. Measles deaths have declined by 80 percent since 1990.

In the decade since the MDGs were minted, the global health community has course corrected, Gibbons said. Through the Countdown to 2015 initiative, launched in 2005, for example, the UN now monitors progress on a number of high-impact indicators.

“We’re figuring things out,” she said. “But did we lose time because there was a decrease in attention to the most high-impact diseases during the early part of the decade? I think it’s a valid question that deserves some attention as we’re making post-2015 plans.”

Families with a child with food allergies know keeping their kids safe can be costly, especially when it comes to medical treatment and missed work in the event of an incident.

A new study puts a number on those costs across the United States: $25 billion a year.

Researchers report in the Sept. 16 issue of JAMA Pediatrics that the U.S. health care system and families are hit with a heavy tab when it comes to medical care, purchasing allergy-free foods and other out-of-pocket expenses for these children.

“In summary, childhood food allergy in the United States places a considerable economic burden on families and society,” concluded the study’s authors.

For the study, Chicago researchers surveyed more than 1,600 caregivers of a child with a food allergy, looking specifically at the economic impact of care. Caregivers were asked how much they spent on doctor’s visits, trips to the emergency room and how much they spent on special foods and treatments.

The researchers calculated about $4,180 in costs per child each year. Breaking down the $24.8 billion overall total, $4.3 billion went to direct medical costs from going to the doctor or ER, and $770 million went to family-related costs like time off work. $5.5 billion was spent on other out-of-pocket expenses — 31 percent of which was spent on special foods alone, more than $750 per family per year — and $14.2 billion was racked up for lost opportunity, meaning a caregiver had to leave or change jobs due to the food allergy.

Parents “end up having to spend extra on foods to make sure they are safe,” study author Dr. Ruchi Gupta, an associate professor of pediatrics and primary care at Ann & Robert H. Lurie Children’s Hospital of Chicago, said to USA Today. That often means shopping at more expensive grocery stores, she added.

About 8 percent of U.S. kids have food allergies, rates which have been increasing in recent decades. More than 30 percent of those kids are allergic to multiple foods, the American Academy of Allergy, Asthma and Immunology notes, and nearly 40 percent of food allergic children have a history of severe reactions that can lead to medical care.

Food allergies occur when a disease-fighting antibody in the immune system reacts to a specific food, treating it as if it was a foreign-invading disease. That can cause a reaction ranging from mild to severe, inflaming tissues throughout the body, leading to symptoms like itching or swelling in the mouth, hives, tightening of the throat, breathing difficulties, drops in blood pressure, and gastrointestinal issues like vomiting, diarrhea and abdominal pain.

A severe, whole-body allergic reaction called anaphylaxis may also occur, which requires emergency medical attention.

One of the most common and severe food allergies is to peanuts, affecting about 0.6 percent of Americans, the National Institute of Allergy and Infectious Diseases notes. While children may outgrow some allergies to foods including milk, eggs, soy and wheat, the NIAID points out they’re far less likely to outgrow allergies to nuts.

The researchers called on more grocery stores to carry more items for food allergic children, and schools to have sufficient plans in place to prevent allergic reactions or get kids treated faster, as ways to curb costs.

“Given these findings, research to develop an effective food allergy treatment and cure is critically needed,” they added.

In July, the House of Representatives passed legislation that would grant preferences to states that come up with policies to make epinephrine, or EpiPens, available in schools to treat potentially deadly anaphylaxis stemming from a reaction.

Earlier that month, a Sacramento 13-year-old died after eating a Rice Krispies treat containing peanut butter at a local summer camp for families.


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